Endovascular treatment of Budd–Chiari syndrome: Single center experience

Rathod, Krantikumar; Deshmukh, Hemant; Shukla, Akash; Popat, Bhavesh; Pandey, Ankur; Gupte, Amit; Gupta, Deepak; Bhatia, Shobna

doi:10.1111/jgh.13456

Cited by 27 publications

(15 citation statements)

References 30 publications

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“…The results in our study were somewhat consistent with those of ‘step‐wise’ treatment by Han et al (10 patients needed subsequent HV recanalization and seven patients needed subsequent TIPS out of 177 patients) and by Fu et al (eight patients needed subsequent HV recanalization out of 62 patients). In contrast, only a fraction of wBCS patients receive percutaneous recanalization and rather most receive TIPS . This difference of treatment in aBCS and wBCS is because of different baseline patient characteristics and therefore, it is almost impossible to apply treatment algorithm of wBCS to aBCS patients and vice versa.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of individualized treatment strategy in treatment of type I Budd‐Chiari syndrome in 456 patients

Ding

Han

Liu

et al. 2019

Liver International

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Abbreviations: BCS, Budd-Chiari syndrome; HV, hepatic vein; ITS, individualized treatment strategy; IVC, inferior vena cava; MELD score, model for end-stage liver disease score; MOVC, membranous obstruction of the inferior vena cava; PTA, percutaneous transluminal balloon angioplasty; SOVC, segmental obstruction of the inferior vena cava; TIPS, transjugular intrahepatic portosystemic shunt.Abstract Aim: To evaluate individualized treatment strategy (ITS) and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) with obstructed inferior vena cava (IVC) based on different degrees of hepatic vein (HV) involvement. , 456 consecutive patients with BCS with obstructed IVC underwent endovascular treatment with ITS. All patients received IVC recanalization. Then, 426 patients with at least one patent HV received no additional treatment. Twenty-fivepatients with membranous or segmental occlusion of HVs underwent HV recanalization and for the remaining five patients with diffuse HVs occlusion, a transjugular intrahepatic portosystemic shunt (TIPS) was performed.Results: The endovascular treatment was technically successful in 455 of the 456 patients (99.8%). The complication rate was 5.0% (23/456), with major complications in 13 patients (2.8%) and minor complications in 10 patients (2.2%). Median follow-up time was 60.5 months (range, 4-120 months). The cumulative 1-, 2-, 5-and 10-year primary vessel patency rates were 93.6%, 89.9%, 80.5% and 74.3% respectively and the cumulative 1-, 2-, 5-, 10-year secondary patency rates were 99.8%, 99.8%, 98.2% and 97.2% respectively. The cumulative 1-, 2-, 5-and 10-year survival rates were 98.4%, 95.8%, 91.2% and 76.5% respectively. Illness duration and decreased serum albumin were independent predictors of survival. Conclusion:The ITS for Asian BCS with obstructed IVC and varying degrees of HV involvement appears to be effective and with good long-term outcomes. K E Y W O R D Sangioplasty, Budd-Chiari syndrome, hepatic vein, inferior vena cava

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Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of individualized treatment strategy in treatment of type I Budd‐Chiari syndrome in 456 patients

Ding

Han

Liu

et al. 2019

Liver International

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“…Numerous observational studies demonstrate very good long-term outcomes despite TIPSS being technically more challenging 4 93–104. The largest series demonstrate very good symptom resolution exceeding 70%, and excellent long-term outcomes with 5-year survival rates exceeding 70%.…”

Section: Indications For Tipssmentioning

confidence: 99%

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Tripathi

Stanley

Hayes

et al. 2020

Gut

194

220

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These guidelines on transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the management of portal hypertension have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the Liver Section of the BSG. The guidelines are new and have been produced in collaboration with the British Society of Interventional Radiology (BSIR) and British Association of the Study of the Liver (BASL). The guidelines development group comprises elected members of the BSG Liver Section, representation from BASL, a nursing representative and two patient representatives. The quality of evidence and grading of recommendations was appraised using the GRADE system. These guidelines are aimed at healthcare professionals considering referring a patient for a TIPSS. They comprise the following subheadings: indications; patient selection; procedural details; complications; and research agenda. They are not designed to address: the management of the underlying liver disease; the role of TIPSS in children; or complex technical and procedural aspects of TIPSS.

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“…HVC‐BCS patients have undergone percutaneous recanalisation more frequently as compared to classical BCS patients . Several studies have shown good long‐term efficacy and survival‐benefit of this procedure (Table ) …”

Section: Radiological Interventionmentioning

confidence: 99%

“…Angioplasty has been extensively used in Asia with good long‐term outcomes (Table ) . Han et al published their experience in 168 Chinese BCS patients undergoing successful percutaneous angioplasty with median follow‐up of 30 months .…”

Section: Radiological Interventionmentioning

confidence: 99%

Review article: a multidisciplinary approach to the diagnosis and management of Budd‐Chiari syndrome

Khan

Armstrong

Mehrzad

et al. 2019

Aliment Pharmacol Ther

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Background: Budd-Chiari syndrome (BCS) is a rare but fatal disease caused by obstruction in the hepatic venous outflow tract. Aim: To provide an update of the pathophysiology, aetiology, diagnosis, management and follow-up of BCS. Methods: Analysis of recent literature by using Medline, PubMed and EMBASE databases. Results: Primary BCS is usually caused by thrombosis and is further classified into "classical BCS" type where obstruction occurs within the hepatic vein and "hepatic vena cava BCS" which involves thrombosis of the intra/suprahepatic portion of the inferior vena cava (IVC). BCS patients often have a combination of prothrombotic risk factors. Aetiology and presentation differ between Western and certain Asian countries. Myeloproliferative neoplasms are present in 35%-50% of European patients and are usually associated with the JAK2-V617F mutation. Clinical presentation is diverse and BCS should be excluded in any patient with acute or chronic liver disease. Non-invasive imaging (Doppler ultrasound, computed tomography, or magnetic resonance imaging) usually provides the diagnosis. Liver biopsy should be obtained if small vessel BCS is suspected. Stepwise management strategy includes anticoagulation, treatment of identified prothrombotic risk factors, percutaneous revascularisation and transjugular intrahepatic portosystemic stent shunt to re-establish hepatic venous drainage, and liver transplantation in unresponsive patients. This strategy provides a 5-year survival rate of nearly 90%. Long-term outcome is influenced by any underlying haematological condition and development of hepatocellular carcinoma. Conclusions: With the advent of newer treatment strategies and improved understanding of BCS, outcomes in this rare disease have improved over the last three decades. An underlying haematological disorder can be the major determinant of outcome. Primary BCS is considered a multifactorial disease and multicentre data found a combination of several prothrombotic conditions in 25% to 46% of the patients with BCS, 11,19-21 several times greater than expected in the general population. The discovery of one causal factor should not discourage further investigation to identify other prothrombotic conditions. Multifactorial causes may explain the rarity of BCS. 2 The prothrombotic conditions found in BCS, in particular the classical type, include: Factor V Leiden mutation, prothrombin (PT) gene mutation, protein C deficiency, protein S deficiency, antithrombin deficiency, antiphospholipid syndrome, hyperhomocysteinemia and paroxysmal nocturnal haemoglobinuria. 22 BCS is also associated with systemic inflammatory diseases, such as Behçet's disease, sarcoidosis, vasculitis and other connective tissue diseases. 22 A detailed description of the frequency of inherited/acquired thrombophilias and risk factors found in patients with BCS compared to those with portal vein thrombosis is summarised by Poisson and colleagues. 23

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Endovascular treatment of Budd–Chiari syndrome: Single center experience

Abstract: Our study demonstrates that venous recanalization and TIPSS for BCS are safe and efficacious.

Cited by 27 publications

References 30 publications

Long‐term outcomes of individualized treatment strategy in treatment of type I Budd‐Chiari syndrome in 456 patients

Long‐term outcomes of individualized treatment strategy in treatment of type I Budd‐Chiari syndrome in 456 patients

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Review article: a multidisciplinary approach to the diagnosis and management of Budd‐Chiari syndrome

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